[Operational planning of health services: How do we make it possible?] / Planificación operativa en servicios sanitarios: ¿cómo lo hacemos posible?

INTRODUCTION AND OBJECTIVE: The Catalan Health Service carries out the operational planning of service delivery and organization. The goal is to describe the methodology and procedure followed to perform these functions. METHODS: The process of operational planning in healthcare services (OPHS) is continuous, dynamic, participatory, objective, and adaptable. OPHS can be divided into three stages prior to implementation and evaluation: Service delivery planning, Organization of healthcare resources, and Procurement planning. RESULTS: Three examples of projects are presented following the POSS framework. It is essential to adapt the process to the characteristics of each project. CONCLUSIONS: The proposed framework is useful to achieve high quality and equity in access to services.

[Results of a benchmarking exercise for primary care teams in Barcelona, Spain]. / Resultado de la aplicación del benchmarking en los equipos de atención primaria de Barcelona.

OBJECTIVE: To identify primary care teams (PCT) with the best overall performance and compare these with other PCT with benchmarking methods. DESIGN: Descriptive, cross-sectional study of a set of indictors for the year 2002. SETTING: City of Barcelona (northeastern Spain). PARTICIPANTS: Thirteen seven PCT with more than 2 years' experience, and 771,811 inhabitants in the catchment area. MAIN MEASURES: Indicators were chosen from among those proposed by an advisory group, depending on feasibility of obtaining information. A total of 17 indicators in 4 dimensions were studied: accessibility, clinical effectiveness, case management capacity, and cost-efficiency. Each PCT was scored for each indicator based on the percentile group in the distribution of scores, and for each dimension based on the mean score for all indicators in a given dimension. Overall score for PCT performance was calculated as the weighted sum of the scores for each dimension. As descriptive variables we analyzed time operating under the revised administrative system, patient visits per population served, the population's economic capacity and age of the population. RESULTS. Nine PCT were identified as the benchmark group. Teams in this group had been operating under the revised administrative system for significantly longer than other PCT. In comparison to other PCT, the benchmark group obtained higher scores on all four dimensions, better results on 14 separate indicators, the same results for 1 indicator, and worse results for 2 indicators. CONCLUSIONS. Benchmarking made it possible to identify PCT with the best performance, and to identify areas in need of improvement. This approach is a potentially useful tool for self-evaluation and for stimulating a dynamic for improvement in primary care providers.

[Consensus on a process of benchmarking in primary care in Barcelona]. / Consenso sobre un proceso de benchmarking en la atención primaria de salud de Barcelona.

OBJECTIVE: To define the strategy, the conceptual framework, the methodology and the indicators that are needed to promote and consolidate the culture of external reference (benchmarking) as a strategy for change in Primary Care teams (PCT). DESIGN: Cross-sectional, descriptive study. SETTING: Primary care services of the Barcelona City Health Region. METHOD: Two stages were distinguished. At the first stage, an adviser group was set up. This was divided into 4 focus groups in which the main lines, the conceptual framework, the sizes, the indicators and the methodology for comparing PCTs were agreed. The second stage, that of prioritization, was conducted by means of a questionnaire to opinion-formers. For each of the indicators proposed, they appraised the degree of agreement, the suitability and relevance of indicators, the capacity of PC to modify results and the practicality of the information for composing the indicators. RESULTS: The involvement of professionals, their approach to improvement, and the transparency and dissemination of the evaluation were identified as strategic elements of benchmarking dynamics. In line with the basic principles of PC and the health system, 6 dimensions for evaluation were set: accessibility, effectiveness, capacity to resolve problems, longitudinality, cost-efficiency, and results. 43 of the 57 indicators prioritized gained the consensus of over 90% of the consultants. CONCLUSIONS: Evaluation as a useful tool for managing PC quality has to generate improvements or changes in PCTs. The involvement of professionals in the design and development of evaluation may help both its acceptance and the implementation of the changes arising from it. The indicators used and the effect of benchmarking policy on the results of PC service delivery require evaluation.

Resultado de la aplicación del benchmarking en los equipos de atención primaria de Barcelona / Results of benchmarking exercise for primary care teams in Barcelona, Spain

Objetivo. Identificar los equipos de atención primaria (EAP) con mejores resultados globales y compararlos con el resto de los EAP mediante la aplicación de una metodología de benchmarking. Diseño. Estudio descriptivo, transversal, de un conjunto de indicadores del año 2002.Emplazamiento. Ciudad de Barcelona. Participantes. Un total de 37 EAP con más de 2 años de funcionamiento y 771.811habitantes de referencia. Mediciones principales. La selección de indicadores se realizó a partir de las propuestas de un grupo asesor y la factibilidad de la información. Se seleccionaron 17 indicadores agrupados en 4dimensiones: accesibilidad, efectividad, capacidad resolutiva y relación coste eficiencia. Cada EAP obtuvo una puntuación por indicador, asignada según el percentil que ocupó en la distribución de valores, y una puntuación por dimensión, que era la media de la puntuación de los indicadores que agrupaba. Se elaboró una puntuación sintética del resultado del EAP a partir de la suma ponderada de las dimensiones. Como variables descriptivas se analizaron el tiempo de reforma, las visitas por población atendida, la capacidad económica de la población y el envejecimiento. Resultados. Se identificaron 9 EAP como grupo bench mark (BM). El BM presentó más tiempo de implantación de la reforma que el resto de los EAP, con diferencias estadísticamente significativas. El BM obtuvo puntuaciones más elevadas en las 4dimensiones, mejores resultados en 14indicadores, igual resultado en 1 e inferior en 2.Conclusiones. El benchmarking permitió reconocer a los EAP con mejores resultados e identificar los ámbitos de mejora. Puede ser un instrumento útil de autoevaluación y para estimular dinámicas de mejora de los proveedores de atención primaria

Objective. To identify primary care teams (PCT) with the best overall performance and compare these with other PCT with benchmarking methods. Design. Descriptive, cross-sectional study of a set of indictors for the year 2002.Setting. City of Barcelona (northeastern Spain). Participants. Thirteen seven PCT with more than 2 years’ experience, and 771 811inhabitants in the catchment area. Main measures. Indicators were chosen from among those proposed by an advisory group, depending on feasibility of obtaining information. A total of 17 indicators in 4dimensions were studied: accessibility, clinical effectiveness, case management capacity, and cost-efficiency. Each PCT was scored for each indicator based on the percentile group in the distribution of scores, and for each dimension based on the mean score for all indicators in a given dimension. Overall score for PCT performance was calculated as the weighted sum of the scores for each dimension. As descriptive variables we analyzed time operating under the revised administrative system, patient visits per population served, the population’s economic capacity and age of the population. Results. Nine PCT were identified as the benchmark group. Teams in this group had been operating under the revised administrative system for significantly longer than other PCT. In comparison to other PCT, the benchmark group obtained higher scores on all four dimensions, better results on 14 separate indicators, the same results for 1 indicator, and worse results for2 indicators. Conclusions. Benchmarking made it possible to identify PCT with the best performance, and to identify areas in need of improvement. This approach is a potentially useful tool for self-evaluation and for stimulating a dynamic for improvement in primary care providers

Consenso sobre un proceso de benchmarking en la atención primaria de salud de Barcelona / Consensus on a process of benchmarking in primary care in Barcelona

Objetivo. Definir la estrategia, el marco conceptual, la metodología y los indicadores que han de impulsar y consolidar la cultura de la referencia externa (benchmarking) como estrategia de cambio en los equipos de atención primaria (EAP). Diseño. Estudio descriptivo, transversal. Emplazamiento. Servicios de atención primaria (AP) de la Región Sanitaria de la ciudad de Barcelona. Método. Se distinguen 2 fases. En la primera se constituyó un grupo asesor (GA) que se organizó en 4 grupos focales, donde se acordaron los ejes, el marco conceptual, las dimensiones, los indicadores y la metodología para la comparación de los EAP. La segunda fase, de priorización, se realizó a través de una encuesta a líderes de opinión, quienes para cada uno de los indicadores propuestos valoraron el grado de acuerdo y la adecuación de los indicadores, su relevancia, la capacidad de la AP para modificar el resultado y la factibilidad de la información para su elaboración. Resultados. La implicación de los profesionales, la orientación hacia la mejora, la transparencia y la difusión de la evaluación fueron identificados como elementos estratégicos de la dinámica de benchmarking. De acuerdo con los principios básicos de la AP y del sistema sanitario, se concretaron 6 dimensiones de evaluación: accesibilidad, efectividad, capacidad resolutiva, longitudinalidad, relación coste eficiencia y resultados. En 43 de los 57 indicadores priorizados se obtuvo el consenso de más del 90% de los consultores. Conclusiones. La evaluación como instrumento útil para la gestión de la calidad de la AP ha de generar acciones de mejora o cambio en los EAP. La implicación de los profesionales en su diseño y desarrollo puede ayudar a su aceptabilidad y a la implementación de las acciones de cambio que se deriven. Es necesario evaluar los indicadores utilizados y analizar la influencia que ha tenido la política de benchmarking en los resultados de la prestación de los servicios de AP

Objective. To define the strategy, the conceptual framework, the methodology and the indicators that are needed to promote and consolidate the culture of external reference (benchmarking) as a strategy for change in Primary Care teams (PCT). Design. Cross-sectional, descriptive study. Setting. Primary care services of the Barcelona City Health Region. Method. Two stages were distinguished. At the first stage, an adviser group was set up. This was divided into 4 focus groups in which the main lines, the conceptual framework, the sizes, the indicators and the methodology for comparing PCTs were agreed. The second stage that of prioritisation, was conducted by means of a questionnaire to opinion-formers. For each of the indicators proposed, they appraised the degree of agreement, the suitability and relevance of indicators, the capacity of PC to modify results and the practicality of the information for composing the indicators. Results. The involvement of professionals, their approach to improvement, and the transparency and dissemination of the evaluation were identified as strategic elements of benchmarking dynamics. In line with the basic principles of PC and the health system, 6 dimensions for evaluation were set: accessibility, effectiveness, capacity to resolve problems, longitudinality, cost-efficiency, and results. 43 of the 57 indicators prioritised gained the consensus of over 90% of the consultants. Conclusions. Evaluation as a useful tool for managing PC quality has to generate improvements or changes in PCTs. The involvement of professionals in the design and development of evaluation may help both its acceptance and the implementation of the changes arising from it. The indicators used and the effect of benchmarking policy on the results of PC service delivery require evaluation

Análisis de la demanda en los servicios de urgencias de Barcelona / Analysis of demand in the emergency services of Barcelona

No disponible

[Functional classification of chronic alcoholic hepatopathy in primary care]. / Clasificación funcional de la hepatopatía crónica alcohólica en atención primaria.

OBJECTIVE: To evaluate the use of Pugh's Classification in assessing patients with diffuse alcoholic Chronic Hepatopathy in the out-patient context. DESIGN: Descriptive-retrospective study. SITE. The Base Health Area of "La Mina" in Barcelona. PATIENTS OR OTHER PARTICIPANTS: 143 patients over the age of 14 diagnosed as suffering diffuse chronic Hepatopathy were identified. 37 of these were excluded because of lack of data. MAIN MEASUREMENTS AND RESULTS: The following data were gathered: those relating to semeiology, anamnesis, quantifying alcoholic intake, where the original diagnosis was made, how rapidly the condition evolved, laboratory and complementary explorations' parameters. Out of the 106 patients studied 71 (67%) were classified in group A; 22 (21%) in B and 13 (12%) in C. No significant differences were found in relation to age or sex. Significant differences concerning the speed of the condition's evolution and the average intake in grammes of alcohol per day were observable. The number of hospital admissions increased as the patient's functional stage became worse and complications increased. CONCLUSIONS: Pugh's test was shown to be useful in the out-patient context for classifying patients suffering chronic diffuse Hepatopathy in line with the severity of their condition.

[Hereditary familial neuropathies: genetic counseling and early diagnosis in primary care]. / Neuropatías heredofamiliaries: consejo genético y diagnóstico precoz en atención primaria.

We present 5 cases of sensitive-motor hereditary neuropathies which were detected or controlled in primary care. Four patients had Charcot-Marie-Tooth disease (type I) and the remaining patient is a carrier of Dejerine-Sottas disease (type III). Regardless of the age of presentation of the disease, the evolution has been slow but steady in all cases. Talipes cavus is the most frequent secondary deformity. An electroneuromyographic study and a neural biopsy were the complementary diagnostic tests used. Three of the patients presented family antecedents. We believe that early diagnosis, family study and genetic advice are of great importance in primary care.

[Cardiovascular risk factors. An audit of their detection in primary care]. / Factores de riesgo cardiovascular. Audit de su detección en atención primaria.

After having found that the prevalences of hypertension, hypercholesterolemia, obesity and smoking were low in our adult population on care, we developed a study to investigate the causes of the problem and to introduce measures for its solution following the methodology of the medical audit. The indexes showed that the performance of preventive cardiovascular activities (PCVA) was low: blood pressure measurement 45%, blood cholesterol determination 23%, height and weight measurement 8% and questioning on smoking habits 40%. After the implementation of corrective measures, indexes of 79%, 76%, 71% and 56%, respectively, have been achieved. In addition, a defective recording of the detected risk factors was found: 87% in the clinical history record, 72% in the age and sex card; after the corrective measures, the rates were 98% and 91% respectively. The present study demonstrates the effectiveness of quality control measures carried out by the professionals responsible for care to improve its quality.

[Amoxicillin/clavulanic acid and trimethoprim in the treatment of urinary infection in primary care]. / Amoxicilina/ácido clavulánico y trimetoprim en el tratamiento de la infección urinaria en atención primaria.

The effectiveness of amoxicillin/clavulanic acid (A/Cl) and trimetoprim (TMP) were compared in two different schedules: 10 days treatment and monodose, in 80 patients with, urinary tract infection (UTI) demonstrated by urine culture. The patients over 65 years, the males and those with underlying risk conditions randomly received A/Cl or TMP during 10 days. The rates of cure were 76.9% for A/Cl and 73.9% for TMP. The difference was not significant. Thirty-one patients without those features randomly received a short A/Cl course or a single dose of TMP. The rates of cure were 92.8% for A/Cl and 58.8% for TMP. The difference was statistically significant. It was concluded that, in our patients, complicated lower UTI have a similar response rate to a ten days course of A/Cl or TMP, whereas A/Cl for three days is more effective than a single TMP dose to treat noncomplicated lower UTI.

[Monoclonal gammapathy of uncertain significance. A perspective from the primary care setting]. / Gammapatía monoclonal de significado incierto. Una perspectiva desde la atención primaria.

Eight cases of monoclonal gammapathy of uncertain significance are reported. They were detected from routine analysis in patients from the general population who consulted for several diseases to a primary care center. One patient developed multiple myeloma and the rest remained stable. As there is no effective method to identify which patients with monoclonal gammapathy of uncertain significance will undergo a malignant transformation, it is suggested that periodical clinical and laboratory controls are the only effective means for the monitoring of this type of patients.